Which description best captures the critique of end-of-life care in the article by Atul Gawande?

• A. The system perfectly matches patient priorities and expense is well-managed.
• B. The system often spends heavily in the final year with limited benefit, while patient priorities emphasize comfort and presence with family.
• C. End-of-life care is uniformly cost-effective and satisfying to patients.
• D. Patients universally prefer maximum medical intervention regardless of impact.

Answer: (B)

The main idea being tested is that end-of-life care often is characterized by high costs and aggressive treatment in the final year of life, even when the medical benefit is limited, while many patients prioritize comfort and time with family. Gawande argues that the healthcare system tends to pursue costly interventions that may not meaningfully improve quality or length of life, and that patients commonly value relief from suffering and being present with loved ones over extending life at any cost. This makes the description that the system spends heavily in the final year with limited benefit, while patient priorities emphasize comfort and presence with family the best fit. The other statements imply perfect alignment, universal cost-effectiveness, or universal preference for maximal intervention, which run counter to his critique and the real tensions he highlights between care goals and spending.